An unassisted birth

Monday

Nov 23, 2009 at 11:30 AM

When Jennifer Margulis went into labor with her fourth child, she sent her husband off to take the kids to school, then waited at home for her body to do what she felt confident it had evolved over millions of years to do on its own.

Jeff Barnard

When Jennifer Margulis went into labor with her fourth child, she sent her husband off to take the kids to school, then waited at home for her body to do what she felt confident it had evolved over millions of years to do on its own.

There was no rushing to the hospital, no midwife, no EMTs. Just Jennifer and her husband, home alone, giving birth.

"I think a lot of people think a woman who would want to have an unassisted birth would be a little bit crazy," said Margulis, who holds a Ph.D. in literature, and is a contributing editor for Mothering Magazine. "I think I may have had that reaction as well. I am definitely not a crazy person. I am a very educated, thoughtful and caring person. I am not a person who takes a lot of unnecessary risks. The whole point is it is not risky if you do your homework."

Nationwide, 90 percent of births still take place in hospitals with doctors attending, said Oregon State University medical anthropologist and midwife Melissa Cheney. Another 8 to 10 percent are with midwives in hospitals or birthing centers. And 1 to 2 percent are at home.

The numbers of at-home births that are unattended are impossible to track, Cheney said.

But Internet traffic and books on the subject indicate more women are choosing to take control with what is becoming known as freebirth because they are concerned about the United States' dismal record of maternity care and skyrocketing rate of Cesarean births, now at nearly 32 percent of all births, Cheney said.

"I don't think they are just crazy," said Cheney. "I think they are trying to find a way to work around a system they see as very problematic."

Though the United States spends more money on childbirth than any other nation, it has one of the world's worst records for infant mortality and maternal mortality, said Cheney. The infant mortality rate is nearly 7 infant deaths per 1,000 live births, according to the Centers for Disease Control and Prevention, ranking the U.S. 30th in the world in 2005.

"The U.S. is really the butt of lots of international public health jokes," Cheney said. "'What a waste of money,' is usually the punchline."

Dr. Erin Tracy, an obstetrician and gynecologist at Massachusetts General Hospital in Boston and assistant professor at Harvard medical School, said most women can give birth alone without any problem, but there are still small numbers — as high as 10 percent — who will run into complications, often without warning.

"What worries me is that very often women who have absolutely no risk factors develop an emergency complication," she said. "I can't imagine how you can possibly recognize that yourself, particularly if you have no medical training. Sometimes you have only minutes to intervene."

Tracy said the increase in C-sections appears driven by the high rate of obesity in America, more births of twins and triplets, more women asking for them, as well as the fear of lawsuits. The high infant mortality rate is related to the high number of premature births that can survive for a time.

"None of these make it, I think, a wise choice to have a delivery in a setting where no one has any training," she said.

Margulis' decision to have her child without medical help evolved.

She had a bad experience with her first birth in a hospital, and her second birth, which was with a midwife at home. A midwife also assisted with the third, but this midwife had half of her own 10 children unassisted, and was an inspiration for the idea. Margulis began interviewing midwives for her fourth birth, but as she learned more about doing it herself, she became convinced she could.

"I felt like when I read other peoples' stories, I felt like those were the most amazing women in the world and they were all so much stronger than I am," she said. "It wasn't true. In no way am I special or amazing. It's that if we let our bodies do what they evolved to do, what they know how to do, then any woman can have a safe unassisted home birth."

Jennifer Block, author of the book, "Pushed," said while it is impossible to track the numbers of women doing unassisted childbirth, they are highly educated, committed, motivated, and frustrated with mainstream medicine.

"That should give us pause," she said. "We are failing in some way. Women should be able to be in control and still have trained support with them. Emergencies do happen. I can't imagine trying to resuscitate my own infant, or if I had a hemorrhage."

Margulis said she lied to her mother, University of Massachusetts Amherst evolutionist Lynn Margulis, a member of the National Academy of Sciences, about having a midwife present. Lynn Margulis said she's nonetheless proud of her daughter.

"I'm delighted. Her father and I used to say, when people asked how may kids do you have, we used to say, 'We have a daughter and a half,'" she said.

Laura Shanley, a leading advocate for freebirth, had her first child in 1978 without a doctor or midwife at home. She and her husband were inspired by the book "Childbirth Without Fear," by the late British obstetrician Grantly Dick-Read, widely regarded as the father of the natural childbirth movement. She went on to have all five of her children that way. One died of a congenital heart defect soon after birth, she said.

Shanley later wrote her own book and established a Web site called Bornfree!

"It didn't make sense to me that the thing that assures the continuation of the race would be this horrendous experience," she said.

Margulis' husband James Di Properzio was not convinced at first. He was worried about the few births that do not go smoothly.

"I wanted to know what the contingency was, and how we were going to know when to go to the contingency," he said. Being a short drive from the hospital and having a midwife standing by to call helped, he said.

Jennifer went into labor the night before, and in the morning told di Properzio to take the kids, Hesperus, Athena and Etani, to school. When he came back, she got into the shower, where she stayed under a stream of warm water until she felt the urge to push. De Properzio helped her into the bedroom, where she gave birth to a healthy girl — Leone Francesca — who di Properzio caught.

"Once the baby was out she was asking if it was OK," James said. "I felt completely calm and confident. I was chuckling and laughing with joy as the baby's head was coming out and not concerned at all."

Jennifer said it was one of the hardest things she had ever done in her life.

"And I am still in awe of the fact I am here to tell you about it," she said. "Once she was born, we were both laughing. We were laughing and crying at the same time. I said, 'We actually did it. we did it ourselves.'"